Transarterial embolization for convexity dural arteriovenous fistula with or without pial arterial supply: A report of four patients

Abstract

Background: Convexity dural arteriovenous fistulae (dAVF) usually reflux into cortical veins without involving the venous sinuses. Although direct drainage ligation is curative, transarterial embolization (TAE) may be an alternative treatment. Case Description: Between September 2018 and January 2021, we encountered four patients with convexity dAVFs. They were three males and one female; their age ranged from 36 to 73 years. The initial symptom was headache (n = 1) or seizure (n = 2); one patient was asymptomatic. In all patients, the feeders were external carotid arteries with drainage into the cortical veins; in two patients, there was pial arterial supply from the middle cerebral artery. All patients were successfully treated by TAE alone using either Onyx or N-butyl cyanoacrylate embolization. Two patients required two sessions. All dAVFs were completely occluded and follow-up MRI or angiograms confirmed no recurrence. Conclusion: Our small series suggests that TAE with a liquid embolic material is an appropriate first-line treatment in patients with convexity dAVFs with or without pial arterial supply.

Non-Sinus Type Dural Arteriovenous Fistula: Others

“…Hence, it may be reasonable for patients with convexity dAVFs and pial arterial supply to undergo direct surgery. Recently, nevertheless, Korai et al 21) reported two cases of convexity dAVFs with pial arterial supply successfully treated with liquid embolic materials (n-butyl-2-cyanoacrylate [NBCA], Onyx). While both NBCA and Onyx possess the potential to flow into the pial artery, Onyx is considered more effective in eliminating the fistula because the liquid material tends to flow toward the venous side, which is under lower pressure, before filling the pial arterial feeders.…”

“…Apart from parasagittal dAVF, alternative names such as falcine dAVF, dAVF at the falx cerebri, convexity dAVF (near the SSS), convexity-SSS dAVF, type 4 SSS dAVF, and dAVF in the SSS region have been used. 21,[24][25][26][27][28][29] Among them, falcine dAVF and dAVF at the falx cerebri must be classified as falcine dAVFs in this review. The other non-sinus-type dAVFs nearby or adjacent to SSS are included in the parasagittal dAVF.…”